From PBS News <[email protected]>
Subject Proposed changes to Medicaid
Date May 14, 2025 1:28 AM
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It’s Tuesday, the traditional day for elections and for our pause-and-consider newsletter on politics and policy. We think of it as a mini-magazine in your inbox.

WHAT’S IN AND WHAT’S OUT: THE LATEST HOUSE BUDGET PROPOSALS
By Lisa Desjardins, @LisaDNews ([link removed])
Correspondent

Capitol Hill is shifting to higher gears. Fast.

In the next two weeks, House Republicans hope to pass one of the largest bills, in dollar figures, in U.S. history. It envisions trillions in tax cuts and trillions in spending cuts.

We have been writing about what *may* be in this bill for months. But now we have specifics.

Let’s dig in.

Reconciliation and Trump’s ‘big, beautiful bill’

Reconciliation is a budget process that is used by Congress as a shortcut ([link removed]) to get around the Senate’s 60-vote majority rules. It requires just 51 Senate votes, and Republicans have 53.

Not every bill can be a reconciliation bill. Among other requirements, proposals must have a substantial budgetary effect.

President Donald Trump likes to call the effort on his agenda the “one big beautiful bill.” That’s the reconciliation bill.

In the past two days, the three leading committees steering this process released their proposed plans:
* Energy and Commerce ([link removed])
* Ways and Means ([link removed])
* Agriculture ([link removed])

A reminder: These proposals are not final steps. These details could change as these committees mark up Trump’s bill overnight. And Republicans likely will change it again next week.

But these are critical, initial lines in the sand. Here is what I saw that stood out.

What’s in the Energy and Commerce draft bill

The House Energy and Commerce Committee oversees Medicaid as well as key pieces of the energy picture. Here is their section-by-section summary. ([link removed]) Here are my highlights:

Health care
* CUTS. The GOP did NOT enact some cuts feared by Medicaid advocates. In particular, limits on spending per capita and direct changes to the Federal Medical Assistance Percentage, which is the government’s share of Medicaid costs.
* But. The committee proposal did freeze a key funding mechanism for states — taxes on health care providers. This is complicated. Some states, members have told me directly, have made money on Medicaid because of these taxes. But, in general, this change likely will affect the landscape in many states, forcing them to choose between robust Medicaid programs and their state budgets.
* Work requirements. This mandates an 80-hour-a-month work requirement for all states for “able-bodied” adults (those without disabilities) aged 19 to 64.
* With these changes, how many people would lose their insurance? Democrats published an estimate from the nonpartisan Congressional Budget Office that found that some 8.6 million fewer people ([link removed]) would have health insurance by 2034.
* Medicaid expansion sunsetted for new states. The bill turns off a 5 percent federal boost to states that expand Medicaid under the American Rescue Plan. This means new states could not get it.
* Pharmacy benefit managers. The proposal bans “spread pricing” in Medicaid by PBMs, or companies that manage prescription drug benefits for health insurers and other large entities. It would also force more transparency in pricing by PBMs.
* Planned Parenthood. The proposal bans Medicaid payments to nonprofits engaged in family planning, reproductive health or abortion care.
* Undocumented immigrants. States offering health coverage for them will see funds cut.
* Transition-related medical care. The proposal bans Medicaid and Children’s Health Insurance Program (CHIP) funding for transition-related medical care for youth. It would prohibit this care being considered as an “essential health benefit” for all Americans.


Energy
* Electric vehicle tax credits. This proposal repeals credits and other programs related to low-emissions vehicles.
* Natural gas. A few things in here of note. The proposal creates an expedited permitting process, at the cost of $10 million per applicant. And it creates a $1,000,000 fee for exporting natural gas out of the U.S. to any country without a free trade agreement with the U.S. (There are more questions here.)
* Wireless spectrum. Republicans hope to raise some $88 billion from auctions.


Overall: The GOP met its dollar mark, per CBO ([link removed]) , surpassing its $880 billion savings target.

What’s in the Way and Means draft bill

The Ways and Means Committee is the power player here. The tax writing committee will spend the most and potentially impact the most lives with the tax cuts it passes in this bill, and those it rescinds. Here is the section-by-section summary. ([link removed])

There is a lot I’m leaving out, but I don’t want to overwhelm. Here are my highlights:

Tax cuts
* 2017 tax rate cuts will be permanent for all incomes. Republicans estimate that spares American families from an average 22 percent tax hike. ([link removed]) Top rates stay the same. No millionaire tax.
* Standard deduction. Will increase by $2,000 for couples and $1,000 for individuals for four years.
* Child tax credit. The max goes from $2,000 to $2,500 for four years. This is limited to, essentially, U.S. citizens only.
* New account for kids. Kids born over a specific, nearly five-year period ([link removed]) , who are U.S. citizens at birth, would get a $1,000 account for families to invest.
* Tips. No taxes on tips for four years. The Treasury Secretary will determine which occupations get this.
* Overtime. No taxes on overtime for four years. High-earners blocked.
* Seniors: What’s out. There is NO proposal to end taxes on Social Security, a Trump promise.
* Seniors: What’s in. Instead, there is a new deduction of $4,000 for those over 65 who make $75,000 or less ($150,000 for couples). This also is for four years.
* SALT. The bill caps state and local tax deductions at $30,000 for people with up to $400,000 in income. That’s too low for a bunch of New Yorkers and California Republicans.
* Corporations. Few things change for them in a tax system that benefits them now.
* Universities are in a different boat. Some could pay up to 21 percent on endowment income. The rate depends on the size of the endowment/wealth.
* Private K-12 schools. There’s a new proposal to allow taxpayers to contribute up to 10 percent of their income toward a private school scholarship fund. ([link removed])

Green energy incentives. At the same time, the Ways and Means Committee is ending or phasing out some significant green energy tax incentives. Republicans see these as contrary to Trump’s “Drill, baby drill!” campaign pledge, and is a significant flexing of federal muscle in favor of fossil fuels. Democrats and others say ending these incentives is an environmental and economic mistake.
* What’s out: EV tax credits. The credit for most new EVs would end at the end of this year.
* Clean electricity production and investment credits are phased out over next six years.
* Zero-emissions nuclear credits are also phasing out.


Student loan forgiveness is also being repealed.

Want even more? Here is the 432-page description ([link removed]) of the bill from the Joint Committee on Taxation.

What’s in the Agriculture draft bill

The Agriculture Committee — which is, by the way, one of my favorites in Congress — is in the spotlight for its proposed reform of the SNAP, or the Supplemental Nutrition Assistance Program formerly known as “food stamps.” Here is the section-by-section summary. ([link removed])

SNAP
* SNAP cost sharing. Right now, 100 percent of SNAP benefits are funded by the federal government. This bill pushes more of the cost onto states, based on how poorly the state handles its payments (its error rate). This proposal has all states paying a minimum of 5 percent of SNAP costs, with the highest error-rate states having to pick up a whopping 25 percent. This will be a hard sell in the Senate.
* SNAP work requirements. The bill expands work requirements to “able-bodied” adults, or those without disabilities, up to age 64. (Current limit is 54.). It also limits the exemption for people with a child to children under 7 years old.
* Farm bill. This bill includes some traditional farm bill policy/funding changes. Many people would prefer to pass a farm bill, but the GOP has been unable to get agreement.


Big picture

These committee bills are good tests for what can pass and lay the critical groundwork for any final bill.

Keep in mind: We expect the most important draft to come right before this bill hits the House floor. The “manager’s amendment” will be the most important draft for House Republicans.

And the Senate has yet to weigh in. Republicans there will want changes as well.

It is a moment where the Trump agenda in Congress can start rolling down the rails — or get off track.

And we will be watching.
More on politics from our coverage:
* Watch: What’s next for Trump’s trade war after pausing tariffs with China. ([link removed])
* One Big Question: Was Trump’s tariffs plan to be tough and then negotiate all along? NPR’s Tamara Keith and Amy Walter of the Cook Political Report with Amy Walter discuss. ([link removed])
* A Closer Look: What to expect after Trump signs order demanding lower prices from drug companies. ([link removed])
* Perspectives: An aid group warns of “catastrophic” conditions in Gaza ([link removed]) as Israeli blockade enters its third month.

THIS WEEK’S TRIVIA QUESTION
By Joshua Barajas
Senior Editor, Digital

Since the first use of reconciliation in 1980, Congress has sent the president 27 such bills ([link removed]) , according to the Congressional Research Service.

That includes the Inflation Reduction Act, a reconciliation measure that then-President Joe Biden signed into law in 2022.

But four of the 27 reconciliation bills were not signed into law. Former President Barack Obama vetoed one during his second term. The other three were vetoed by another Democratic president.

Our question: Which U.S. president has vetoed those three reconciliation bills?

Send your answers to [email protected] (mailto:[email protected]) or tweet using #PoliticsTrivia. The first correct answers will earn a shout-out next week.

Last week, we asked: Which PBS TV show that relied on the Ready To Learn grant was based on a series of children’s books about a giant pet who was bigger than a horse?

The answer: Clifford the Big Red Dog. ([link removed]) Author Norman Bridwell once called the red hound “Tiny,” but his wife convinced him to change it to “Clifford” ([link removed]) after her childhood imaginary friend, according to the National Museum of American History.

Congratulations to our winners: Dean M. Gottehrer and Stephanie Pennello!

Thank you all for reading and watching. We’ll drop into your inbox next week.
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